Cognitive function and cardiorespiratory fitness affect gait speed in type-2 diabetic patients without neuropathy.

AIM: To identify physical, cognitive, and metabolic factors affecting gait speed in patients with type-2 diabetes mellitus (T2DM) without neuropathy. METHODS: This cross-sectional study enrolled 71 diabetic patients without neuropathy (mean age 55.87±7.74 years, 85.9% women). Neuropathy status was assessed with Douleur Neuropathique 4. We used a cut-off point for gait speed of 1 m/s to classify the participants into two groups: slow walkers (SW) and average and brisk walkers (ABW). The groups were compared in terms of age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), fasting glucose, systolic blood pressure, maximal aerobic capacity (VO2 max), percentage of muscle mass, percentage of lower extremity muscle mass, Mini-Mental State Examination (MMSE) score, and years of education. RESULTS: Compared with the ABW group, the SW group had significantly lower VO2 max (14.49±2.95 vs 16.25±2.94 mL/kg/min) and MMSE score (25.01±3.21 vs 27.35±1.97), fewer years of education, and these patients were more frequently women (P<0.05). In the multivariate regression models, the combination of VO2 max, sex, and MMSE score explained only 23.5% of gait speed (P<0.001). MMSE score and VO2max independently determined gait speed after adjustment for age, BMI, HbA1c, fasting glucose, systolic blood pressure, percent of muscle mass, percent of lower extremity muscle mass, and years of education. CONCLUSION: In diabetic patients without neuropathy, physical impairment and disability could be prevented by an improvement in aerobic capacity and cognitive function.

Efficacy of local oxygen-ozone therapy for the treatment of digital ulcer refractory to medical therapy in systemic sclerosis: A randomized controlled study.

BACKGROUND: This study aimed to investigate the efficacy of local oxygen-ozone therapy in systemic sclerosis (SSc) patients with digital ulcers (DUs) who were resistant to medical therapy and had impairment in activities of daily living. METHODS: Participants' demographic data, and clinical parameters were recorded. Twenty-five SSc patients with DUs were randomized to the ozone group (I) (n = 13) to receive medical treatment plus local oxygen-ozone therapy and the control group (II) (n = 12) to receive medical treatment only. Hand functions were assessed using the Health Assessment Questionnaire (HAQ) and the Modified Hand Mobility in Scleroderma (HAMISm) test. Clinical parameters, HAQ, and mHAMIS scores were re-evaluated in participants 4 weeks after the initiation of treatment. RESULTS: Demographic and clinical characteristics of the two groups showed no significant differences. At 4 weeks after the initial treatment, the efficacy rate was significantly higher in the ozone group than that in the control group (92% versus 42% P = 0.010). Clinical parameters, HAQ, and HAMISm scores were significantly improved in the treatment group compared to those in the control group (P < 0.05). CONCLUSION: Local oxygen-ozone therapy was effective in the treatment of SSc patients with resistant DUs and improved clinical parameters and functional disability.

Arterial and intraocular pressure changes after a single-session hot-water immersion.

BACKGROUND/AIMS: The aim of this study is to investigate the effect of head-out hot-water immersion on the intraocular pressure (IOP) of healthy subjects and investigate whether this intervention alters cardiovascular and microcirculatory responses. METHODs: 16 male and 18 female healthy young adults were immersed in 39 degrees C water up to shoulder level for 20 minutes. Blood pressure (BP), heart rate (HR) and IOP were measured pre-immersion, post-immersion and five minutes after immersion on the same day. Tono-Pen was used to measure IOP. Mean arterial blood pressure (MAP), systolic pressure rate product (S-PRP), diastolic pressure rate product (D-PRP), pulse pressure (PP), mean ocular perfusion pressure (mean-OPP), systolic ocular perfusion pressure (S-OPP) and diastolic ocular perfusion pressure (D-OPP) were calculated. RESULTS: Systolic BP (SBP), diastolic BP (DBP), MAP, IOP, S-OPP, D-OPP and mean-OPP decreased; HR increased five minutes after immersion in the pool and post-immersion out of the pool significantly, compared to pre-immersion data (p < 0.05). HR, S-PRP and D-PRP measured five minutes after immersion were significantly higher from post-immersion (p < 0.05). PP and S-OPP were significantly different five minutes after immersion compared to pre-immersion. There was no statistically significant correlation between IOP and SBP, DBP, MAP, S-PRP, D-PRP, PP, S-OPP, D-OPP, or mean-OPP (p > 0.05). CONCLUSIONS: Physiological hemodynamic response to single head-out hot-water immersion caused a statistically significant decrease in IOP. Preliminary results could help to clarify vascular reactions and IOP changes during hot-water immersion that might be potentially therapeutic in glaucoma patients.

Turkish version of the painDETECT questionnaire in the assessment of neuropathic pain: a validity and reliability study.

OBJECTIVES: The aim of this study was to develop a Turkish version of the painDETECT questionnaire (PD-Q) and assess its reliability and validity. METHODS: Two hundred and forty patients who were diagnosed by expert pain physicians in daily clinical practice and classified as having either neuropathic, nociceptive, or mixed pain for at least 3 months were enrolled in this study. After the usual translation process, the Turkish version of the PD-Q was administered to each participant twice with an interval of 48 hours. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Douleur Neuropathique en 4 questions (DN4) and a pain visual analog scale were assessed along with the PD-Q. Chronbach's α was calculated to evaluate internal consistency of the PD-Q. Intraclass correlation coefficient was calculated to examine test-retest reliability. Convergent validity was assessed by correlating the scale with LANSS and DN4. Discriminant statistics-sensitivity, specificity, Youden index, positive predictive value, negative predictive value-were also assessed. RESULTS: A total of 240 patients with chronic pain, 80 patients in each neuropathic, nociceptive, and mixed pain group, were included in this study. Mean age of the patients was 54.1 years, and majority of the patients were female (52.9%). Chronbach's α of the Turkish version of the PD-Q was 0.81. The test-retest reliability of the Turkish version of the PD-Q was determined as 0.98 for the total score and ranged from 0.86 to 0.99 for individual items. The Turkish version of the PD-Q was possitively and significantly corralated with LANSS (r 0.89, P < 0.001) and DN4 (r 0.82, P < 0.001). When the two cutoff values in the original version were used, sensitivity was found 77.5% for a cutoff value ≤19, and specificity was 82.5%. Sensitivity and specificity were 90% and 67.5%, respectively, for the other cutoff value ≤12. Scores ≤12 represents a negative predictive value = 87%, and scores 19≤ represents a positive predictive value = 82%. When mixed pain patients were included in the neuropathic pain group, discriminant values were reduced as expected. CONCLUSIONS: The Turkish version of the PD-Q is a reliable and valid scale to be used to determine neuropathic component of chronic pain in Turkish patients.

Ultrasonographic evaluation of the femoral cartilage thickness after unilateral arthroscopic partial meniscectomy.

PURPOSE: To assess the distal femoral cartilage after unilateral arthroscopic partial meniscectomy and to explore the relationship between cartilage thickness and various disease-/surgery-related parameters. METHODS: Eighty-nine patients (42 M, 47 F) who had undergone arthroscopic partial meniscectomy surgery were evaluated. Ultrasonographic distal femoral cartilage thicknesses were measured with a 5-13-MHz linear probe (General Electric, Logiq P5) on mid-points of the lateral condyle, intercondylar notch and medial condyle of operated and non-operated knees by a physician blinded to patients' data. Demographic features, duration after surgery, type of meniscal tear and site of meniscectomy were recorded. RESULTS: Mean age of the patients was 51.8 ± 12.8 years (range 18-88). Mean body mass index was 29.4 ± 4.4 kg/m2 (range 18-38). Overall, in patients with degenerative meniscal tears, femoral cartilage thicknesses pertaining to all the three measured sites (lateral, intercondylar and medial) were found to be decreased in the operated knees when compared with those of the non-operated knees (p = 0.004, p = 0.003, p = 0.041, respectively), whereas in patients with non-degenerative tears, this decrease was significant only in the intercondylar area (p = 0.038). When patients were grouped according to the duration (months) after their surgery (≤36, 37-48 and ≥49), cartilage thickness was similar between both knees in the first group, decreased at the lateral condyle (p = 0.008) and intercondylar area (p = 0.049) in the second group and decreased at all three sites (lateral, intercondylar and medial) in the third group (p = 0.015, p = 0.005 and p = 0.008, respectively). CONCLUSION: These findings would be considered as unfavourable with respect to weight-bearing, and thus, conservative measures to support relevant joints would strongly be kept in mind during clinical practice. Lastly, ultrasonography may be a convenient alternative imaging method for the evaluation of short- and medium-term cartilage loss in patients with arthroscopic partial meniscectomy. LEVELS OF EVIDENCE: III.

Hemorheological responses to progressive resistance exercise training in healthy young males.

BACKGROUND: This study aimed to explore the effects of progressive resistance exercise training (PRET) on hemorheology. MATERIAL/METHODS: Exercise sessions included 1-3 sets of 8-12 repetitions at 40-60% of 1-repetition maximum (1-RM) for 3 weeks and at 75-80% of 1-RM during weeks 4-12. Red blood cell (RBC) deformability and aggregation were determined by ektacytometry, plasma and whole blood viscosities (WBV) by rotational viscometry. Lactate concentration was evaluated by an analyzer and fibrinogen was evaluated by coagulometry. Plasma total oxidant/antioxidant status was measured by colorimetry. RESULTS: Following an acute increase after exercise on the first day, RBC deformability was elevated during weeks 3 and 4 (p=0.028; p=0.034, respectively). The last exercise protocol applied in week 12 again caused an acute increase in this parameter (p=0.034). RBC aggregation was increased acutely on the first day, but decreased after that throughout the protocol (p<0.05). At weeks 4 and 12 pre-exercise measurements of WBV at standard hematocrit and plasma viscosity were decreased (p=0.05; p=0.041, respectively), while post-exercise values were increased (p=0.005; p=0.04, respectively). Post-exercise WBV at autologous hematocrit measured at week 12 was increased (p=0.01). Lactate was elevated after each exercise session (p<0.05). Fibrinogen was decreased on the third week (p<0.01), while it was increased on the 4th week (p=0.005). Plasma antioxidant status was increased at week 3 (p=0.034) and oxidative stress index was decreased at week 4 (p=0.013) after exercise. CONCLUSIONS: The results of this study indicate that PRET may have positive effects on hemorheological parameters.

The effect of mud pack therapy on serum YKL-40 and hsCRP levels in patients with knee osteoarthritis.

The aim of this study was to evaluate the efficacy of treatment with mud pack in knee osteoarthritis (OA) and to determine whether mud pack effects serum levels of YKL-40 and high-sensitivity C-reactive protein (hsCRP) which are reported to be biological markers for articular damage or inflammation in patients with OA. Forty-four patients with the diagnosis of knee OA assigned into two groups were treated with local natural mineral-rich mud pack or hot pack. Treatments were applied for 6 days a week for 2 weeks as a total of 12 sessions. Patients were assessed at baseline, post-treatment, and 3 months after the treatment. VAS, range of motion, 15-m walking time, WOMAC index, Nottingham Health Profile, serum YKL-40, and hsCRP levels were the outcome measures. Pain intensity and joint stiffness decreased in both groups at all follow-ups. Physical activity status was found to persist for 3 months after treatment only in mud pack group. Serum mean YKL-40 and hsCRP levels of the patients were higher compared to healthy control group. Serum YKL-40 level increased significantly only in hot pack group 3 months after the treatment (P < 0.017). No significant change was observed in hsCRP levels in both groups during the whole follow-up periods (P > 0.05). Mud pack and hot pack therapy were both demonstrated to be effective in symptomatic treatment of knee OA until the end of the 2-week treatment period, whereas only mud pack therapy was shown to be effective in functional status over time. In the hot pack group, increased serum YKL-40 level 3 months after the treatment might indicate persistence of cartilage degradation. Maintenance of YKL-40 level in mud pack therapy seems to slow down the progression of knee OA.

Short- and long-term results of clinical effectiveness of sodium hyaluronate injection in supraspinatus tendinitis.

The objective of the study is to evaluate the short- and long-term effect of intraarticular sodium hyaluronate (SH) application in patients diagnosed with supraspinatus tendinitis (ST) that have shoulder pain on the clinical symptoms of the patients through comparison with conventional physiotherapy methods. A total of 24 patients were included in the study and were randomized into two groups.SH injection and physical therapy modalities (PTM) were administered to Group I and Group II, respectively. Home exercise programs were recommended to all of the patients in both groups. The patients were evaluated using the pain severity [Visual Analog Scale (VAS)], range of motion and functional evaluation (FE) parameters pertaining to pre-treatment, 3rd week, 3rd month and 4th year post-treatment. Patient's global effectiveness (PGE) evaluation was performed in the 3rd month and 4th year of the treatment. There were no statistically significant differences for Group I's resting VAS value between pre-treatment controls and controls in the 3rd week and 3rd month, no statistically significant differences were detected for Group II in passive flexion between pre-treatment and the 4th year, also in passive external rotation between pre-treatment and 3rd week (P > 0.05). A statistically significant recovery was detected in both groups in all the other evaluation parameters (P < 0.05). When evaluation was performed among groups, active abduction in the control in the 3rd month, VAS by movement and a statistically significant difference in favor of Group I in FE were determined (P < 0.05). No statistically significant differences were found among groups in PGE (P > 0.05). It was concluded that physical therapy modalities and SH application supplemented by home exercise programs were similar effects in short- and long term for ST which causes pain in shoulder and SH application may be a better alternative with regard to effectiveness and side effects for other treatment methods applied intraarticulary.

Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy. DESIGN: Randomized, prospective, controlled single-blind trial. SETTING: Department of physical medicine and rehabilitation, university hospital. SUBJECTS: Forty-five patients who had undergone surgery for arthroscopic partial meniscectomy were randomly divided into three groups with 15 patients in each group. INTERVENTIONS: The control group had home exercise, the second and third groups received electromyographic biofeedback training or electrical stimulation therapy to quadriceps muscle in addition to home exercise. MAIN MEASURES: The patients were evaluated for: visual analogue scale, gait velocity (m/s), time using a walking aid after surgery, Lysholm Knee Scoring Scale score, knee flexion-extension angle, maximum and average contraction powers of vastus medialis obliquus and vastus lateralis muscles on the day before the operation and two and six weeks after. RESULTS: The time using a walking aid was 8.3 ± 8.0, 1.5 ± 2.5 and 4.5 ± 5.5 days, respectively, for the home exercise, electromyographic biofeedback training and electrical stimulation groups, and significantly shorter in the electromyographic biofeedback training than in the home exercise group (P < 0.017). While significant progress was detected in Lysholm Knee Scoring Scale score in the second and sixth postoperative weeks compared to the preoperative within-group evaluation for each of the three groups (P < 0.017), there was significant difference in Lysholm Knee Scoring Scale in the second postoperative week in favour of electromyographic biofeedback training compared to home exercise (P < 0.017). There were significant differences in vastus medialis obliquus average and vastus lateralis maximum and average contractions in favour of electromyographic biofeedback compared to home exercise and electrical stimulation in the second postoperative week (P < 0.017). CONCLUSIONS: The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process.

Effects of different types of exercises on pain, quality of life, depression, and body composition in women with fibromyalgia: A three-arm, parallel-group, randomized trial.

Objectives: This study aims to compare the efficacy of three different exercise types on pain, health-related quality of life (HRQoL), depression, and body composition in women with fibromyalgia (FM). Patients and methods: Between June 2019 and December 2019, a total of 41 women with FM (mean age: 46.7+9.4 years; range, 24 to 62 years) were randomly allocated into Group 1 (n=13, supervised aerobic plus stretching), Group 2 (n=13, supervised resistance plus stretching), and Group 3 (n=15, home-based stretching). All exercises were performed three times per week for 12 weeks and were individualized by measuring the maximal oxygen consumption (VO2max) for aerobic exercise and one-repetition maximum (1-RM) test for resistance exercise. The main measures were pain intensity assessed by the Visual Analog Scale (VAS), severity by the Fibromyalgia Impact Questionnaire (FIQ), symptoms of depression by the Beck Depression Inventory, HRQoL by the Short-Form Health Questionnaire (SF-36), and body composition by bioelectrical impedance analysis. Results: The mean VAS difference (95% confidence interval [CI]): -2.61 (-1.94, -3.29); -2.61 (-1.82, -3.42); -1.07 (-0.49, -1.64) for Group 1, Group 2, and Group 3, respectively (p<0.001); however, there was no significant difference between the combined exercise groups. The FIQ scores decreased significantly in all exercise groups after training (p<0.05). At 12 weeks, 21 (80.8%) patients from combined groups and six (40%) patients from the stretching alone group achieved a minimal clinically significant difference defined as a 14% change in baseline FIQ scores (p=0.008). Other outcome parameters did not differ significantly among the groups. Conclusion: Supervised aerobics/muscle strengthening combined with stretching exercises reduced pain, and FM severity more than a home stretching exercise alone.

Effectiveness of conventional versus virtual reality-based vestibular rehabilitation exercises in elderly patients with dizziness: a randomized controlled study with 6-month follow-up.

OBJECTIVES: To investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness. METHODS: In this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n=16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n=16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment. RESULTS: Statistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p<0.05). Also, there were significant improvements in the VSS, all DHI subgroups, and total scores, BBT, HAS in Group 1 compared to Group 2 at the 6-months after the treatment (p<0.05). CONCLUSION: The application of vestibular rehabilitation in a virtual reality environment can lead to additional improvements especially in dizziness symptoms, disability, balance, and mobility in the elderly with chronic dizziness.

Determination of the position on which the median nerve compression is at the lowest in carpal tunnel syndrome and clinical effectiveness of custom splint application.

To evaluate the clinical effectiveness of wrist splint usage arranged by determining the optimal position on which the median nerve is compressed the least through sonographic examination for patients with carpal tunnel syndrome (CTS). This study was a prospective, clinical trial with a 6-week follow-up. Twenty-four patients diagnosed clinically and electromyographically with CTS were included in the study. A total of 37 wrists were studied on. When the patients were grouped according to the optimal position, Group I comprising 16 (43.24%) wrists was at 15 degree flexion, Group II comprising 12 (32.43%) wrists was neutral, Group III comprising 6 (16.22%) wrists was at 15° extension and Group IV comprising 3 (8.11%) wrists was at 30° extension configurations. Groups I, II and III were included in clinical follow-up. Symptom severity score (SSS), functional status score (FSS), Grip strength and Pinch strength were used for the clinical follow-up and evaluation of the patients. When pre- and post-treatment were compared, a statistically significant recovery was detected in all three groups in respect to SSS (Group I P < 0.01, Group II P < 0.05, Group III P < 0.05). A statistically significant recovery was detected for FSS only in Group I (P < 0.05) and for Grip strength in Group II (P < 0.05). When the groups were compared among themselves, no statistically significant difference was detected for any of the parameters (P > 0.05). In this study, by sonographic examination of the patients included in the study with CTS, we saw that the optimal position on which the median nerve is compressed the least varies depending on the individual and we determined that this position was 15° flexion most frequently for our patients. We also observed that in clinical follow-up of wrist splint usage arranged on custom optimal position results in significant recovery.

Role of rehabilitation in a COVID-19 survivor with intensive care unit-acquired weakness: A case report.

Intensive care unit-acquired weakness (ICU-AW) is a catastrophic and debilitating clinical condition that causes generalized weakness and predisposes to adverse short- and long-term outcomes. Novel coronavirus disease-2019 (COVID-19) has been a global pandemic since November 2019. Each additional ICU admission for COVID-19 stresses intensive care unit (ICU) and hospital capacity. Accurately designed, timely rehabilitation procedures may reduce the patient burden of ICUs and hospitals. In this article, we describe a COVID-19 survivor who developed acute respiratory distress syndrome (ARDS) and ICU-AW. Early pulmonary rehabilitation in the ICU and long-term rehabilitation maintenance after the ICU and hospital discharge resulted in a positive outcome.

Effectiveness of whole-body vibration or biofeedback postural training as an add-on to vestibular exercises rehabilitation therapy in chronic unilateral vestibular weakness: A randomized controlled study.

BACKGROUND: The efforts to achieve better functional results in vestibular rehabilitation have been continued by using different visual and somatosensory stimuli for a long time. Whole-body vibration (WBV) is a mechanical vertical stimulation that provides high frequency vibration stimulus to the proprioceptive receptors. Biofeedback provides continuous information to the subject regarding postural changes. These techniques may aid to improve vestibular rehabilitation. OBJECTIVE: We aimed to investigate the effect of adding WBV or biofeedback postural training (BPT) to standard rehabilitation exercises in patients with chronic unilateral vestibular weakness. METHODS: Ninety patients were randomized into three groups. Group 1 had WBV and Group 2 BPT in addition to the standard rehabilitation exercises. Group 3 only carried out the home-based exercises and served as the control. Outcome measures such as static posturography, Berg Balance Scale, Timed Up-and-Go test, Visual Analog Scale, and Dizziness Handicap Inventory (DHI) were used for comparison. RESULTS: Statistically significant gains were achieved in all groups with all parameters at the end of treatment when compared to baseline (p < 0.05). The patients in Group 1 (WBV), however, were significantly better than those in Groups 2 and 3 at the static posturographic stability score, Berg Balance Scale, and DHI (p < 0.05). CONCLUSION: Adding WBV to a rehabilitation program may be an effective strategy to improve postural stability and achieve better physical, functional and emotional outcomes.

Successful treatment with adalimumab in a patient with coexisting Behçet's disease and ankylosing spondylitis.

The objective is to report a patient with concomitant ankylosing spondylitis (AS) and Behçet's disease (BD) successfully treated with adalimumab. A 44-year-old male diagnosed as AS applied to our outpatient clinic with complaints of morning stiffness, pain and limitation of motion at spine, concurrence of oral and genital ulcerated lesions. He was on sulfasalazine together with different NSAIDs for the past 1 year. According to the criteria of International Study Group, he was diagnosed as BD. The patient was considered as refractory to current treatment and adalimumab treatment was started. During follow-up, not only AS was in remission, but also no new oral and genital ulcerations appeared. There were no complications related to the use of anti-TNFalpha therapy. In our case it was observed that anti-TNFalpha therapy, specifically adalimumab, was effective for symptoms of both AS and BD.

Health-related quality of life (Nottingham Health Profile) in knee osteoarthritis: correlation with clinical variables and self-reported disability.

The aims of this study were to assess the health-related quality of life (HRQoL) in patients with knee osteoarthritis (OA) using the Nottingham Health Profile (NHP) and to determine its relationships with conventional clinical measures and self-reported disability. One hundred and forty patients with knee OA (104 female, 36 male, mean age 59.39 ± 7.62 years, mean disease duration 58.56 ± 56.78 months) and 40 sex and age-matched controls were included in the study. HRQoL, disability and pain were assessed using NHP, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), respectively. Results showed that the six subgroups of the NHP revealed higher scores in the knee OA patients compared with controls (p < 0.001). All subgroups of the NHP significantly correlated to VAS-rest, VAS-activity, 15-m walk test and WOMAC scores (p < 0.05, p < 0.01, p < 0.005, p < 0.001, respectively). The knee flexion or restricted extension range of motion was significantly correlated with the pain, energy and physical mobility subgroups of the NHP (p < 0.05, p < 0.005). Although there were statistically significant correlations between the NHP pain, emotional reaction, and physical mobility subgroup scores and body mass index (BMI) (p < 0.01, p < 0.05, p < 0.05, respectively), there were no correlations between all the NHP scores and duration of disease (p > 0.05). We conclude that patients with knee osteoarthritis undergo a significant impact on multiple dimensions of HRQoL, compared with healthy controls. The NHP is related to the clinical status and functional ability of patients with knee OA, and it can be used as a sensitive health status measure for clinical evaluation.

Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial.

OBJECTIVE: To assess the effectiveness of therapeutic exercises alone and in combination with a single physical agent - ultrasound - in patients with lumbar spinal stenosis. DESIGN: Randomized, prospective, controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, University Hospital. SUBJECTS: Forty-five patients presenting with symptoms of neurological claudication and magnetic resonance image-proven lumbar spinal stenosis were assigned to one of three groups: ultrasound plus exercise group (group 1, n =15), sham ultrasound plus exercise group (group 2, n= 15) and no exercise - no treatment group (control group, n = 15). INTERVENTIONS: Stretching and strengthening exercises for lumbar, abdominal, leg muscles as well as low-intensity cycling exercises were given as therapeutic exercises. Ultrasound was applied with 1 mHz, 1.5 W/cm(2) intensity, in continuous mode on the back muscle for 10 minutes in group 1 while ultrasound on/off mode was applied in group 2. MAIN OUTCOME MEASURES: Before and after a three-week period, all subjects were evaluated by pain, disability, functional capacity and consumption of analgesic. RESULTS: Thirty-two of the participants were women and 13 were men, with an average age of 53.2 +/- 12.68 years (range 25-82 years). After a three-week treatment period, leg pain decreased in group 1 (-1.47 +/- 3.02) and group 2 (-2.47 +/- 3.75) compared with the control group (P<0.05). Disability score decreased in group 1 (-3.94 +/- 7.20) and group 2 (-7.80 +/- 10.26) compared with control group (P<0.05). We did not find any statistically significant difference between groups 1 and 2 (P>0.05). The amount of analgesic consumption is significantly less in the group with ultrasound application compared to that in the control group (P<0.05). CONCLUSION: The results of our study suggest that therapeutic exercises are effective for pain and disability in patients with lumbar spinal stenosis and that addition of ultrasound to exercise therapy lowers the analgesic intake substantially.

The Correlations Between Disease Specific Quality of Life, Short Form-36 and Clinical Variables in Patients With Ankylosing Spondylitis.

OBJECTIVES: This study aims to assess the correlations between disease specific quality of life (QoL), general health status and clinical variables in patients with ankylosing spondylitis (AS), and also to determine a cutoff value for the disease specific QoL questionnaire. PATIENTS AND METHODS: A total of 124 patients (80 males, 44 females; mean age 40.6±11.1 years; range, 20 to 65 years) who fulfilled the modified New York criteria for AS were included in this cross-sectional study. All patients received a comprehensive rheumatologic assessment including disease specific instruments for disease activity, functional status, spinal mobility and QoL. Furthermore, short form-36 (SF-36) was used to determine general health status. Pain levels of the patients were assessed with visual analog scale (VAS). Pearson's analysis was used to assess correlation among variables, with moderate, strong, or very strong correlations if the value was between 0.40-0.69, 0.70-0.89, and 0.90-0.99, respectively. To determine a cutoff value for the ankylosing spondylitis quality of life (ASQoL) score, the area under the receiver operating characteristic curve (AUC) was computed according to clinical parameters which have the strongest correlations with ASQoL. RESULTS: The mean ASQoL score was 8.8±4.9. There was a significantly positive correlation between ASQoL and disease activity, functional status, spinal mobility and pain VAS whereas there was a significantly negative correlation between ASQoL and the SF-36 subscale scores except for mental health and emotional role (p<0.001). The strongest positive correlation was found between ASQoL and the Bath Ankylosing Spondylitis Disease Activity Index (r=0.721, p<0.001) whereas the strongest negative correlation was found between ASQoL and the first question of SF-36 (r=-0.844, p<0.001). A cutoff value of eight in ASQoL showed good discriminative properties for impaired QoL where sensitivity and specificity were simultaneously maximized according to disease activity (AUC=0.84 [95% confidence interval (CI): 0.770-0.908, p<0.001]) and the patients' global health status (AUC=0.85 [95% CI: 0.782-0.923, p<0.001]) in patients with AS. CONCLUSION: There was a strong correlation between ASQoL and disease activity as well as the patients' global health status in patients with AS. A cutoff value of eight in ASQoL could be used with good discriminative properties for impaired QoL in AS.

Interval Versus Continuous Aerobic Exercise Training in Overweight and Obese Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CONTROLLED STUDY.

PURPOSE: The aim of this study was to compare the efficacy of the supervised pulmonary rehabilitation programs consisting of either an interval or continuous aerobic exercise program, with a home-based exercise program in patients with chronic obstructive pulmonary disease (COPD) who were overweight or obese. METHODS: In this randomized controlled study, 72 overweight and obese patients diagnosed as having COPD were randomly assigned to 3 groups. Group 1 received an interval-type (IT) aerobic exercise program, group 2 received a continuous-type (CT) aerobic exercise program (both groups performed home exercises as well) and group 3 was only given a home-based exercise (HE) program. For the evaluation of patients, anthropometric measures, cardiopulmonary exercise testing (CPX), 6-min walk test (6MWT), modified-Borg dyspnea and leg fatigue scores, St George's Respiratory Questionnaire, and Hospital Anxiety and Depression Scale were used. RESULTS: Both IT and CT groups showed significant improvement on CPX parameters, 6MWT distances, mental health, and health-related quality of life (HRQoL) compared with the HE group in overweight and obese patients with COPD (P < .001). Moreover, the IT group demonstrated a significant decrease in the modified-Borg dyspnea and leg fatigue during the CPX compared with both CT and HE groups (P < .001). Furthermore, the Borg dyspnea and leg fatigue during training were lower in the IT group than in the CT group (P < .05). CONCLUSIONS: An interval or continuous aerobic exercise program added onto a home-based exercise program improved exercise capacity and HRQoL, and reduced anxiety and depression levels in overweight and obese patients with COPD.

A case with rheumatod arthritis and atraumatic odontoid fracture: disappearence of bony landmarks.

We aim to draw attention to occult, atraumatic fractures of the odontoid process in patients with rheumatoid arthritis (RA) and to underline difficulties encountered during clinical and radiological diagnosis. A forty-seven years old man with RA for 4 years had occipital pain for 1 year without any history of trauma. Later, he developed weakness in the upper extremities, but he did not realize weakness in the lower extremities due to deformities. Contrast magnetic resonance imaging revealed a linear fracture of odontiod process and myelopathy. Cervical computed tomography scan revealed an old fracture border with separated and almost disappeared remnant of the tip of the odontoid without free particles in the cord. It was impossible to evaluate atlantoaxial and vertical subluxations with craniometric measurements due to destruction of the tip of odontoid. Following occipitocervical fusion and decompression and a rehabilitation program, his muscle strength improved; however, functional myelopathy stage did not change. Atraumatic fractures of the odontoid process may be more common than reported and may cause compression of the spinal cord or brain stem. Surgery is the treatment of choice but functional recovery is limited once neuronal damage has occurred. Erosion of the critical landmarks makes it difficult to diagnose and follow up atlantoaxial subluxation and/or vertical subluxation, therefore clinicians should consider radiographical follow-ups during the course of the disease.